Neurology & Pain Management Coding Alert

Purchasing power will change the rules for using modifiers 26, TC Reporting modifiers 26 (Professional component) and TC (Technical component) for EEGs may seem a breeze, but if you forget to apply modifier 26 on your claim when your neurologist renders the service in a facility setting, you could be setting yourself up for serious double-billing accusations. The issue: Often, coders "don't split up the technical and professional components," says Angela Cook, patient accounts manager with a physician institute in Lecanto, Fla. Don't fall into this trap: Brush up on your professional and technical component modifier skills, and learn what to do when your neurology practice purchases the technical service. Draw the Line Between Modifiers Certain CPT codes, including most diagnostic studies, such as those for EEG code 95822 (Electroencephalogram [EEG]; recording in coma or sleep only), are made up of two components: the technical component (modifier TC) and the professional component (modifier 26). Keep track: "TC is for the entity that owns the equipment," says Peggy Stilley, CPC, office manager for an Oklahoma University-based private physician practice in Tulsa. "The 26 modifier is for the professional interpretation." Break Down Modifier 26 Example: If your neurologist performs a sleeping or comatose EEG with a facility's equipment, you should use 95822 and append modifier 26 to reflect that he interpreted the findings and wrote the report. Check it out: You should not use modifier 26 with procedures that are either 100 percent technical or 100 percent professional. You should use these modifiers only on procedures having both components. Warning: If your neurologist fails to append modifier 26 but the facility bills with modifier TC, the technical portion of the service will have been double-billed. This can lead to accusations of fraud or a demand for repayment, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, CPC-EMS, RCC, CodeRyte coding analyst and coding review teacher. Safeguard: Medicare will not pay a physician for the technical component of services provided in a facility setting, such as inpatient (POS 21) or an outpatient hospital (POS 22) setting. In many cases, the Medicare carrier will deny processing and the physician will need to resubmit a corrected bill with modifier 26 appended. Tackle Modifier TC The facility owning the EEG equipment in the above example would report the EEG code 95822 using modifier TC for its portion of the test. Using modifier TC here indicates to the payer that the facility supplied only the technical component, not the professional interpretation, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. What to Do if Your MD Provides Both Components If your neurologist performs both the technical and professional components in an office setting (POS 11), [...]